Provider Demographics
NPI:1821018003
Name:THE DRUG STORE CO INC
Entity Type:Organization
Organization Name:THE DRUG STORE CO INC
Other - Org Name:LIVINGSTON DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:LONG
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:205-652-9595
Mailing Address - Street 1:PO BOX 1246
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:AL
Mailing Address - Zip Code:35470-1246
Mailing Address - Country:US
Mailing Address - Phone:205-652-9595
Mailing Address - Fax:205-652-5202
Practice Address - Street 1:108 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:AL
Practice Address - Zip Code:35470
Practice Address - Country:US
Practice Address - Phone:205-652-9595
Practice Address - Fax:205-652-5202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
AL1120843336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1990259OtherPK
AL100001652Medicaid